362. A Modified Early Warning Score Predicts Decompensation in COVID-19 Patients

Background: The novel coronavirus disease (COVID-19) results in severe illness in a significant proportion of patients, necessitating a way to discern which patients will become critically ill and which will not In one large case series, 5 0% of patients required an intensive care unit (ICU) and 1 4% died Several models have been developed to assess decompensating patients However, research examining their applicability to COVID-19 patients is limited An accurate predictive model for patients at risk of decompensation is critical for health systems to optimally triage emergencies, care for patients, and allocate resources Methods: An early warning score (EWS) algorithm created within a large academic medical center, with methodology previously described, was applied to COVID-19 patients admitted to this institution 122 COVID-19 patients were included A decompensation event was defined as inpatient mortality or an unanticipated transfer to an ICU from an intermediate medical ward The EWS was calculated at 12-hour and 24-hour intervals Results: Of 122 patients admitted with COVID-19, 28 had a decompensation event, yielding an event rate of 23 0% 8 patients died, 13 transferred to the ICU, and 6 both transferred to the ICU and died Decompensation within 12 and 24 hours were predicted with areas under the curve (AUC) of 0 850 and 0 817, respectively Using a three-tiered risk model, use of the customized EWS score for patients identified as high risk of decompensation had a positive predictive value of 44 4% and 11 1% and specificity of 99 3% and 99 6% and 12- and 24-hour intervals Amongst medium-risk patients, the score had a specificity of 85 0% and 85 4%, respectively Conclusion: This EWS allows for prediction of decompensation, defined as transfer to an ICU or death, in COVID-19 patients with excellent specificity and a high positive predictive value Clinically, implementation of this score can help to identify patients before they decompensate in order to triage at time of presentation and allocate step-down beds, ICU beds, and treatments such as remdesivir